{{$sRegFormJavaScript}}

{{if $reg == 1}}
 <form method="post" action="{{$action}}" name="regform" ENCTYPE="multipart/form-data" onSubmit="return chkform(this)"> 
{{/if}}
    <input type="hidden" name="login_consultante" value="{{$currentUser}}"/>
    <blockquote>
    <h3>{{$title}}</h3>

    <table border=0 cellspacing=0 cellpadding=0>
    <tr><td>
<div id="interdata">
    <table border=0 cellspacing=0 cellpadding=0 >
        <tbody>
		<tr>
			<td class="reg_item">
			{{$LDInterconsultante}}
			</td>
			<td class="reg_input">
			{{$sInterconsultanteInput}}
			</td>
		</tr>
	
		<tr>
			<td class="reg_item">
			{{$LDEstablecimiento}}
			</td>
			<td class="reg_input">
			{{$sEstablecimientoInput}}
			</td>
		</tr>
	
		<tr>
			<td class="reg_item">
			{{$LDEspecialidad}}
			</td>
			<td class="reg_input">
			{{$sEpecialidadRadio}}
			</td>
		</tr>
	
		<tr>
			<td>
				<h3>{{$LDInterData}}</h3>
			</td>
			<td>&nbsp;</td>
		</tr>
		

		<tr>
			<td class="reg_item">
				{{$LDFecha}}
			</td>
			<td class="reg_input">
				{{$sFechaInput}}
			</td>
		</tr>
	
		<tr>
			<td class="reg_item">
				{{$LDPrevias}}
			</td>
			<td class="reg_input">
				{{$sPreviasInput}}
			</td>
		</tr>
		
		<tr>
			<td class="reg_item">
				{{$LDTension}}
			</td>
			<td class="reg_input">
				{{$sTensionInput}}
			</td>
		</tr>
	
		<tr>
			<td class="reg_item">
				{{$LDPulso}}
			</td>
			<td class="reg_input">
				{{$sPulsoInput}}
			</td>
		</tr>

		<tr>
			<td class="reg_item">
				{{$LDFrecuencia}}
			</td>
			<td class="reg_input">
				{{$sFrecuenciaInput}}
			</td>
		</tr>

		<tr>
			<td class="reg_item">
				{{$LDTemp}}
			</td>
			<td class="reg_input">
				{{$sTempInput}}
			</td>
		</tr>

		<tr>
			<td class="reg_item">
				{{$LDSOAP}}
			</td>
			<td class="reg_input">
				<div id="soap_data">No data SOAP</div>
			</td>
		</tr>

                <tr>
			<td class="reg_item">
				{{$LDComentarios}}
			</td>
			<td class="reg_input">
				{{$sComentariosText}}
			</td>
		</tr>

		<tr>
			<td class="reg_item">
				{{$LDArchivos}}
			</td>
			<td class="reg_input">
				{{$sListaArchtext}}{{$sFileBrowser}}
			</td>
		</tr>

		<tr>
		<td><h3>{{$LDPersonData}}</h3></td>
		<td>&nbsp;</td>
		</tr>
		
		<tr>
			<td class="reg_item">
			{{$LDPaciente}}
			</td>
			<td class="reg_input">
			{{$sPacienteInput}}{{$sPacienteMiniCalendar}}
			</td>
		</tr>
	
		<tr>
			<td class="reg_item">
			{{$LDApellido}}
			</td>
			<td class="reg_input">
			{{$sApellidoPacienteInput}}
			</td>
		</tr>

	
		<tr>
			<td class="reg_item">
				{{$LDApellido2}}
			</td>
			<td class="reg_input">
				{{$sApellidoPaciente2Input}}
			</td>
		</tr>
			
		<tr>
			<td class="reg_item">
				{{$LDNombre}}
			</td>
			<td class="reg_input">
				{{$sNombrePacienteInput}}
			</td>
		</tr>
		
	
		<tr>
			<td class="reg_item">
				{{$LDNombre2}}
			</td>
			<td class="reg_input">
				{{$sNombrePaciente2Input}}
			</td>
		</tr>
	
		<tr>
			<td class="reg_item">
				{{$LDSexo}}
			</td>
			<td class="reg_input">
				{{$sFemInput}}{{$LDFem}}
				{{$sMasInput}}{{$LDMas}}
			</td>
		</tr>
	
		<tr>
			<td class="reg_item">
				{{$LDEtnia}}
			</td>
			<td class="reg_input">
				{{$sEtniaCombo}}
			</td>
		</tr>
		
	
		<tr>
			<td class="reg_input">
				&nbsp;
			</td>
			<td class="reg_input">
				{{$LDListarPaciente}}
			</td>
		</tr>

		{{if $estado ==1 || $estado == 2}}	
                <tr>
		<td><h3>{{$LDOtros}}</h3></td>
		<td>&nbsp;</td>
		</tr>
		
		<tr><td colspan="2"><form action="interconsulta-cerrar.php"><table cellpadding="0" cellspacing="0">

		<tr>
			<td class="reg_item">
				{{$LDEstado}}
			</td>
			<td class="reg_input">
				{{$sEstadoInput}}
			</td>
		</tr>

                <tr>
			<td class="reg_item">
				{{$LDMotivoCierre}}
			</td>
			
			<td class="reg_input">

				{{$sMotivoCierreInput}} 
				{{if ($estado == 1)}}<input type="hidden" name="id" value="{{$id}}"><input type="submit" onClick="return validarCierre();" value="Cerrar" id="motivocierre_button" disabled/>{{/if}}

				
			</td>
		</tr>
		</table>

		<div id="traslado_div" style="display: none;">
		<table cellspacing="0" cellpadding="0" border="0">
		<tr>
			<td class="reg_item">
			    {{$LDTraslado}}
			</td>
			<td class="reg_input">
			    {{$sTrasladoInput}}
			</td>
		</tr>
		</table>
		</div>

		<div id="noadherencia_div" style="display: none;">
		<table cellspacing="0" cellpadding="0" border="0">
		<tr>
			<td class="reg_item">
			    {{$LDNoAdherencia}}
			</td>
			<td class="reg_input">
			    {{$sNoAdherenciaInput}}
			</td>
		</tr>
		</table>
		</div>

		<table cellspacing="0" cellpadding="0" border="0">
		<tr>
			<td class="reg_item">
				{{$LDClasificacion}}
			</td>
			<td class="reg_input">
				{{$sClasificacionInput}}
			</td>
		</tr>

		<table cellspacing="0" cellpadding="0" border="0">
		<tr>
			<td class="reg_item">
				{{$LDComentariosClasificacion}}
			</td>
			<td class="reg_input">
				{{$sComentariosClasificacionInput}}
			</td>
		</tr>
		
		</table></form></td></tr>
		{{/if}}

		{{if $sInterconsultadoText}}
		<tr>
			<td><h3>{{$LDResp}}</h3></td>
			<td>&nbsp;</td>
		</tr>
		{{/if}}

		{{if $sInterconsultadoText}}
	
		<tr>
			<td class="reg_item">
				{{$LDInterconsultado}}
			</td>
			<td class="reg_input">
				{{$sInterconsultadoText}}
			</td>
		</tr>
		{{/if}}	

		{{if $sResponseText}}
	
		<tr>
			<td class="reg_item">
				{{$LDResponse}}
			</td>
			<td class="reg_input">
				{{$sResponseText}}
			</td>
		</tr>
		{{/if}}	

		{{if $sDiagnosisText}}
	
		<tr>
			<td class="reg_item">
				{{$LDDiagnosis}}
			</td>
			<td class="reg_input">
				{{$sDiagnosisText}}
			</td>
		</tr>
		{{/if}}	

		{{if $sTreatmentText}}
	
		<tr>
			<td class="reg_item">
				{{$LDTreatment}}
			</td>
			<td class="reg_input">
				{{$sTreatmentText}}
			</td>
		</tr>
		{{/if}}	

		{{if $sObsText}}
		<tr>
			<td class="reg_item">
				{{$LDObs}}
			</td>
			<td class="reg_input">
				{{$sObsText}}
			</td>
		</tr>
		{{/if}}

		{{if $sComentariosRespText}}
		<tr>
			<td class="reg_item">
				{{$LDCommentsResp}}
			</td>
			<td class="reg_input">
				{{$sComentariosRespText}}
			</td>
		</tr>
		{{/if}}

		{{if $sInterconsultadoText}}	
		<tr>
			<td class="reg_item">
				{{$LDArchivos}}
			</td>
			<td class="reg_input">
				{{$sFileBrowserResp}}
			</td>
		</tr>	
		{{/if}}
</tbody>
</table>
</div>
<div id="pregresp">
<blockquote>
<h3>{{$LDPregRes}}</h3>
<table border=0 cellspacing=0 cellpadding=0>
    <tbody>
        {{$sPregRespInput}}
    </tbody>
</table>
</blockquote>
</div>

</td>
   <td valign=top>{{if $reg != 1}}{{$sRegOptions}}{{/if}}</td>
</tr>
</table>
</blockquote>

<p>
{{if $reg == 1}}
	{{$pbSubmit}}
	{{$pbReset}}
{{else}}
	{{$pbResponse}}
	{{$pbEdit}}
	{{$pbAsignar}}
        {{$pbBitacora}}
{{/if}}
</p>
</form>

<script>
{{if $showSoap}}
     request_soap();
{{/if}}
show_basicdata();
showTrasladoNoAdherencia();
</script>
